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Is the doctor-patient relationship turning into a business partnership?

Is the doctor-patient relationship turning into a business partnership?

“The customer is always right.” We all know the saying. It’s a truism in business. Businesses need happy customers. Happy customers keep coming back and they tell their friends. Keeping the customer happy is a businessperson’s number one priority.

Except when the business is a medical practice, and the customer is a patient.

That ever-blurring line between patient and customer is one of the most difficult things to walk in medical practice. On the one hand, people need to keep coming through the door in order to keep it open in the first place, and making sure people have a good experience when they come to you for care is important. On the other, sometimes patients want things that are medically unnecessary or even plainly inappropriate. Finessing situations that fall into that latter category while trying to maintain a pleasant physician-patient relationship can be very difficult, and the pressure is increasing.

Just as with restaurants and movies, there is a seemingly expanding list of websites out there that let you rate your doctors. Parody articles in The Onionabout physicians doling out controlled substances to help their Yelp ratings make me laugh a dry little chuckle as they find a mark uncomfortably close to home. Asreported in a recent Daily Beast article, a new study shows that physicians aren’t that great at telling patients “no,” even when it comes to narcotics. After all, how hard is it really for a disgruntled patient to log into Vitals or Healthgrades and give you a one-star review? How motivated are the generally-satisfied majority of your patients to log on just for the sake of saying something nice about you? Vengeance is a much more satisfying reason to spend the time than bland contentment.

For my part, I can at least say I don’t feel all that much pressure to prescribe controlled substances. (Perk of being a pediatrician, I guess.) But I know a patient who’s unhappy to be leaving without an antibiotic when I see one. Even amongst my colleagues at the office I am particularly parsimonious with the amoxicillin, yet I find myself thinking from time to time “Will it really be all that bad if I just called this kid’s cold a ‘sinus infection’ and gave them an antibiotic? Is one unnecessary prescription going to make all that much difference in the war against drug resistance?”

I’d love to say I never cave, but that wouldn’t be true. I try to make it rare, and it rankles every time it happens, but sometimes I err on the side of treating when I wouldn’t have without the obvious demand for it.

The difficulty isn’t limited to medications. I spend a surprising amount of time talking people out of pointless tests and needless referrals. For some, there is security that comes with just a little more investigating, or with having a specialist weigh in. But just like more treatment doesn’t always mean better care, additional scans and blood draws and consultations don’t always benefit the patient.

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